EP0459945B1 - Einrichtung zur neuromuskulären Elektroreizung - Google Patents

Einrichtung zur neuromuskulären Elektroreizung Download PDF

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Publication number
EP0459945B1
EP0459945B1 EP91810378A EP91810378A EP0459945B1 EP 0459945 B1 EP0459945 B1 EP 0459945B1 EP 91810378 A EP91810378 A EP 91810378A EP 91810378 A EP91810378 A EP 91810378A EP 0459945 B1 EP0459945 B1 EP 0459945B1
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Prior art keywords
stimulation
treatment
software
program
patient
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EP91810378A
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English (en)
French (fr)
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EP0459945A1 (de
Inventor
Roland Brodard
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Med-El Medical Electronics Elektro-Medizinische Ge
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MED EL Elektromedizinische Geraete GmbH
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36003—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of motor muscles, e.g. for walking assistance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36014—External stimulators, e.g. with patch electrodes
    • A61N1/3603—Control systems
    • A61N1/36034—Control systems specified by the stimulation parameters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • A61N1/37211—Means for communicating with stimulators
    • A61N1/37252—Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
    • A61N1/37282—Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data characterised by communication with experts in remote locations using a network

Definitions

  • the present invention relates to a neuromuscular electrical stimulation device.
  • Neuromuscular electrical stimulation consists of a transcutaneous transmission, by means of surface electrodes, of very weak electrical impulses to the nerve and / or to the targeted muscle to cause excitement.
  • the excitation obtained is identical to that which is normally caused by an autogenous physiological nerve impulse.
  • Electromyostimulation is in turn divided into two distinct branches, that of healthy muscle, normally innervated, which is then a functional electromyostimulation, and that of peripherally denervated muscle, which requires totally different stimulation parameters and mode of application. from the previous one.
  • electromyostimulation is to replace a temporary or lasting deficiency in voluntary muscular activity, so as to overcome the consequences, or at least to reduce them, and to shorten the recovery period as much as possible. voluntary activity.
  • the operating frequency range of the fiber I extends over a range of the order of 8 to 25 Herz
  • that of the type II fiber extends over a range of the order of 25 to 65 Herz.
  • any given functional demand determines a muscular contraction characterized by four parameters: its strength, its speed, its duration and its frequency of repetition.
  • the combination of the different values taken by these parameters will therefore require one of the following three routes of energy metabolism of the muscle concerned: the aerobic route, the anaerobic alactic route or the anaerobic lactic route.
  • the aerobic route the anaerobic alactic route or the anaerobic lactic route.
  • the morphological (structural) and metabolic (biochemical) profiles of a muscle fiber capable of ensuring an aerobic or anaerobic pathway, diverge considerably, it follows that not only does there not exist a single and universal type of fibers within the muscle, but it can also be seen that the muscle fibers cannot be rigidly classified into the two types described above.
  • muscle fibers form a continuous spectrum of fibers, with different levels of metabolic organization, adjusted to a wide range of functional demands.
  • muscle tissue is permanently in dynamic balance between degradation (catabolism) and new synthesis (anabolism).
  • This same dynamic balance governs the morphology and metabolic profile that characterize each of the phenotypes of the muscle fibers that make up a given muscle.
  • This same dynamic balance which gives the muscle its extraordinary plasticity: although the initial distribution of the different muscle fibers within a given muscle is of genetic origin, this distribution is not immutable, but it can be modified, as much by a cross innervation, as by a constant specific functional demand imposed on the muscle or even by chronic electromyostimulation. Therefore, the phenotype of a muscle fiber is determined by a set of adequate responses to constant functional demands. Certain predominant patterns of use for locomotion or posture should favor the expression of certain predominant phenotypes.
  • the muscle contains a spectrum of fibers among which certain species form limited populations, constituting metastable entities, corresponding to the types of fibers hitherto generally described.
  • Neuromuscular electrical stimulation systems are already known, comprising a programming device and a stimulating device operating independently of one another.
  • the programming device of these installations is arranged to record a processing program on a read-only information medium, this information medium carrying the program being placed in the stimulating apparatus in order to control it and cause the program to be executed.
  • Such installations are described for example in French patent no 1213080, in the published German patent application no 2903392, in the published European patent application no 0087617 and in the patent application French publication no 2528709.
  • a more advanced installation comprising a programming device (also arranged to record a treatment program on a removable information medium, but with random access memory) which can work on-line with a stimulating device is described in the European patent applications published nos 0197889 and 0316280.
  • the technique set out in these patent applications is based on a working hypothesis which is now outdated, which is based on the distinction mentioned above between so-called slow muscle fibers and so-called fast muscle fibers.
  • This installation is arranged for sequential programming, the duration of a treatment being able to be divided into a certain number of distinct sequences, each one being able to be programmed, so as to generate trains of electrical pulses whose characteristics are adapted to the so-called muscle fibers slow, and other trains of electrical impulses whose characteristics are adapted to so-called fast muscle fibers.
  • the different outputs to the electrodes of a multichannel output stimulator should always be electrically independent, that is to say galvanically isolated from each other and of the earth, and therefore say floating.
  • this device is constituted by a transformer.
  • the duration of transmission of a rectangular pulse of constant current can hardly be extended beyond 400 micro seconds, even at the cost of better quality and an increase in volume of said transformer.
  • This restriction considerably limits the performance of electrostimulation which cannot therefore be applied to peripherally denervated muscles, the stimulation of which imperatively requires pulses of a duration of between 300 and 500 milli seconds.
  • none of the known autonomous and multichannel portable stimulators fulfills the conditions set out above, so as to be able to stimulate both normally innervated muscles and peripherally denervated muscles.
  • the object of the present invention is to provide a neuromuscular electrical stimulation device, in the form of a miniaturized portable autonomous device, which is free from the defects which have just been listed and which makes it possible to satisfy the requirements which the latest knowledge acquired.
  • a neuromuscular electrical stimulation device in the form of a miniaturized portable autonomous device, which is free from the defects which have just been listed and which makes it possible to satisfy the requirements which the latest knowledge acquired.
  • in neuromuscular physiology have proven necessary for electromyostimulation to ensure the closest mimicry of voluntary active muscular training, while retaining a very simple application, ensured by advanced automation.
  • the invention relates to a neuromuscular electrical stimulation device, as defined in claim 1.
  • the device represented in FIG. 1a comprises a commercial computer 1 and a stimulating element 2 connected by a removable cable 3 ensuring an on-line serial link RS 232C.
  • the stimulation element 2 is portable and autonomous. It is controlled by a removable and interchangeable information medium 4, previously programmable according to the treatment required by each patient considered.
  • the stimulation element is executed according to a concept of the miniaturized player style.
  • Its housing 5 contains the constituent parts, mechanical and electronic. It is provided with four pairs of electrodes 6, 6 ′ arranged to be applied to the part to be treated of the patient's body and so as to transmit the trains of electrical stimulation pulses.
  • the stimulation device 2 is equipped with a housing 7 and a connector for receiving the memory card, as well as a connector with removable cable 3 allowing a serial link of the RS 232C type.
  • the stimulation device can therefore be connected without any other to any computer provided with a serial RS 232C interface. It therefore has the decisive advantage of overcoming the need for any specific programming device.
  • Memory cards previously loaded with software in accordance with one of the procedures described above, can of course at any time be connected to a stimulator and operated by the latter either completely independently or in serial connection. -line with computer.
  • serial link allows a real two-way dialogue, called write-read, between the computer and the stimulator.
  • the computer-stimulator direction it allows the transfer of software and of the parameters and data provided for then being processed by said software; while in the stimulator-computer direction, it makes it possible to reread already transferred software, as well as parameters and data stored on the memory card connected to the stimulator.
  • An example is provided by compliance, whose feedback data delivered by the stimulator during the course of the treatment program are stored on the memory card.
  • the stimulator includes a connector with removable cable ensuring the connection with a member for the standard external control 17 common to all the outputs and which makes it possible to globally control the start or the end of a given function, defined by the software. .
  • it includes connectors 15 advantageously provided for the individual control 16 of each output channel.
  • This individual control allows, through the specific software loaded in the device, to control the start or end of the function of the channel concerned and also to remotely adjust the intensity of the force of the contraction, by acting on the current intensity and pulse frequency.
  • the coupling of this control to a suitable external sensor allows the transmission of information to the software of the device and ensures for example a correct functional training of the activity of patient members, based on the data provided by this feedback and closed-loop control.
  • the device comprises a portable and autonomous stimulating element 50, designed so as to allow simple personalization of any parameter using function keys 56, making it possible to free from computer 1 described above.
  • this element is executed according to a concept of the miniaturized player style.
  • Its housing 51 contains the constituent, mechanical and electronic parts. It is provided with four pairs of electrodes 52, 52 ′ arranged to be applied to the part to be treated of the patient's body and so as to transmit the trains of electrical stimulation pulses.
  • the stimulation element is controlled by a removable and interchangeable information medium 53, previously programmable according to the treatment required by each patient considered.
  • the stimulator 50 is arranged in such a way that it is put into operation using one of the function keys 56.
  • the switching function can be assigned to any of the function keys, this button again available for another function after switching on.
  • the activation of the stimulator is effected when any function key is pressed, but of course this activation can also be carried out in any other suitable manner.
  • the present device makes it possible to make the activity of the different output channels, programmable independently of each other , interdependent as required, any parameter of an output channel that can control another output channel. This allows the programming of multiple muscle activities, synergists, alternating synergists-antagonists or complex relay.
  • the electronic circuitry essentially consists of a real microcomputer 20 generating electrical pulses.
  • This microcomputer is made up of traditional elements: processor, ROM memories (read only memory) and random access memory (RAM).
  • This microcomputer is served by an interface 27 for inputting manual commands and external commands.
  • the microcomputer calculates and delivers high frequency pulses to a true isolation cell 21 comprising an inductive transmitter and a demodulator, the latter comprising a full-wave rectifier and a filtering and smoothing cell, so as to constitute a shaping amplifier for outputting the stimulation current to the electrodes; that is to say that the high frequency signal thus obtained is then transmitted and amplified (boosted) inductively, independently for each output; then this signal is rectified, filtered and smoothed, so that the original programmed shape of the pulse at the output of this circuit is again restored.
  • a true isolation cell 21 comprising an inductive transmitter and a demodulator, the latter comprising a full-wave rectifier and a filtering and smoothing cell, so as to constitute a shaping amplifier for outputting the stimulation current to the electrodes; that is to say that the high frequency signal thus obtained is then transmitted and amplified (boosted) inductively, independently for each output; then this signal is rectified, filtered and smoothed, so that the original programmed shape of the pulse at the output of
  • the rectifier stage has been completed by an electronic switch-reverser stage 26 of the polarity, controlled by the software, via an electrical isolation cell 22, constituted by a transformer or an opto-coupler.
  • This method has the advantage of allowing the delivery of pulses of constant current or with variable slope, as represented in FIG. 3, programmed for any duration, or even to provide a true uninterrupted direct current, intended for the therapy, while keeping a permanent check on the polarity of the output current, which also allows, in particular, to generate asymmetric pulses, also called compensated, because the current flow of the active stimulation pulse a, a ′ is then completely compensated by a current flow inverse u, u ′ of lower intensity inactive but prolonged, with the major advantage of balancing (zero mean flow) of the electrical charges at the level of the skin, which is imperative to prevent any burn or electrolytic alteration of the latter.
  • This general design has the advantage that all of the electronic circuitry (hardware) is of the amorphous type, that is to say entirely under the control of the software (software), which ensures maximum flexibility of use and adapting the system.
  • the system operates using two separate software programs, an operating software program and a processing software program, the latter constituting the processing program proper, loaded and stored on the removable and interchangeable information medium 4, respectively 53, each processing program thus constituting a different application program.
  • the operating software can be loaded into an internal RAM of the device, of the RAM type, where it remains permanently stored, until its possible replacement when loading another operating software.
  • the stimulator does not include any residential memory, the operating software also being stored on the removable and interchangeable information medium, from where it dialogues permanently with the microprocessor.
  • the electronic circuitry is powered by batteries or rechargeable batteries 28, incorporated in the housing 5, respectively 51.
  • the intensity of the stimulation current of each output is generally controlled by means of a potentiometer or two momentary keys, one (+) being intended to increase this intensity, while the other (-) decreasing said intensity.
  • the intensity of the current is in fact a complementary control, used essentially to possibly correct the programmed intensity.
  • Such a command therefore also acts by means slaved to the program and to the processor.
  • the controller for controlling the intensity of each output is a single switch 11, respectively 60, rocker with momentary action. In the rest position, it is in the inactive neutral state.
  • the advantage of this device is that it only requires the use of a single finger for its actuation and thus allows precise and rapid adjustment of said intensity by a simple slight movement of this finger on the key.
  • the removable and interchangeable information carrier can be produced in different ways.
  • it is a so-called smart card element 4, respectively 53, in the format of a credit card, containing random access memories of the type EEPROM (electrical erasable programmable read only memory) or RAM (random access memory) and fitted with a connector.
  • EEPROM electrical erasable programmable read only memory
  • RAM random access memory
  • the device is arranged for free scrolling dynamic programming with interactive parameters.
  • the stimulator's microcomputer includes an internal reference clock system, to which the software used is controlled.
  • the user has full capacity for free programming of all stimulation parameters as a function of the time taken. the treatment program; this time-dependent programming is just as valid for the introduction and implementation of a given parameter and its elimination, as for the value assigned to it.
  • the user can freely set, by sampling as a function of time, the value assigned to this parameter , either arbitrarily by referring to his knowledge and experience, or experimentally by using the on-line serial link with the computer or the function keys and by initializing the value of said parameter in real time during the actual running of the treatment program on the patient, and therefore depending on the reactions of said patient.
  • the programming of the stimulator being a free scrolling programming with interactive parameters, it follows that according to the progress of a treatment program, the value of any stimulation parameter can evolve continuously and gradually between previously assigned reference values , while any given parameter can slave another.
  • the frequency of the pulses can thus for example continuously and progressively change from a subtetanic regime to a fully tetanic regime, while the intensity of the corresponding output current, subject to frequency, is therefore corrected and adapted, so also continuous and progressive, to keep the muscular force delivered within almost constant or previously defined limits.
  • Such programming makes it possible to carry out muscular exercise programs which respect a continuous and gradual progression of the intensity of the muscular activity. developed, modeled on the physiology of a similar voluntary training. This condition takes on its full value when performing a series of contractions, such as for example during interval training.
  • the connector 61 of the stimulator of FIG. 1b can be used to make a link of the data bus type allowing the interactive external remote control of the output channels of one or more stimulators coupled in network.
  • the connection can be made by a multiple star serial line, with a central point, the central point being able to be constituted by a computer or any other control device, or by one of the stimulators in which there is introduces a master patient card to which the patient cards of the other pacemakers are slaved.
  • the programming of the pacemaker can be carried out using preset program cards 70, serving standard treatment programs, each program being specific to a given precise medical indication.
  • a list of programs appears on the screen and a standard program can then be chosen, either using the function keys 56, or using a keyboard 65, a computer 66 or any other control device which can be connected to the stimulator via line 67.
  • the chosen program can then be copied to a blank patient program card which can be inserted into the insertion slot 62 after removing the program card 70.
  • the chosen program can then be easily personalized and adapted to the particular case of the patient, using the function keys 56 or any other connected control device to the pacemaker via line 67, during the execution of the treatment, according to the patient's reactions to the stimulation parameters proposed by the initial program.
  • the software uses adequate interpolation functions, such as for example spline functions (functions with polynomials of variable degree from Tchebychev, Lagrange, Spline, etc.) which allow the calculation of a variation curve of the value of the parameter between the various successive samples, so that this value follows a harmoniously progressive and smooth curve.
  • spline functions functions with polynomials of variable degree from Tchebychev, Lagrange, Spline, etc.
  • FIG. 5 An example of a diagram of a train of pulses of duration e comprising an establishment time b and an extinction time d is shown in FIG. 5.
  • the duration c of nominal pulse intensity is equal to ebd .
  • This diagram also illustrates the programmable progressive variation of the frequency of the pulses, as a function of the time t of running of the treatment program, between the points T 1 and T 2 (slope of establishment), then T 3 and T 4 (slope d 'extinction) of sampling-initialization; the value of the frequency and the smoothed envelope curve of the intensity of the pulses between these different points T being calculated by interpolation functions included in the software.
  • An example is provided here by the slaving of the intensity of the stimulation current delivered to each output to the frequency of the electrical pulses delivered to this same output.
  • FIG. 7 shows by way of example the servo-control by the software of the intensity i of the pulses as a function of the programmed variable frequency of the pulses; the result, the force F delivered by the stimulated muscle is thus kept constant.
  • a set of pulse trains e forming a series o is shown in FIG. 8.
  • This diagram also illustrates an example of interactive parameters, namely the progressive programmable variation, as a function of the time t of execution of the treatment program, of the intensity of the stimulation current i, the duration of the pulse trains (from e 1 to e 2 ) and the duration of the pause (from h 1 to h 2 ) between the pulse trains, and this between the points T 1 , T 2 and T 3 of sampling-initialization; the respective values of these parameters and the smoothed envelope curve of the stimulation current i being calculated by interparameter coupling and interpolation functions included in the software.
  • This diagram also illustrates the set of pulse trains contained in the ramp k of the series o, as well as the nominal working phase m.
  • the force delivered by a muscle is the result of the combination of spatial summation and temporal summation, that is to say, in terms of electrostimulation, of the combination of the intensity of the electric pulse and its frequency repetition.
  • the force delivered is equal to the product of the intensity of the current by the frequency of the pulses, multiplied by a variable experimental correction factor.
  • This variable factor the value of which is a function of the frequency of the pulses and of the structure of the fibers making up the muscle in question, can be determined by means of a correlation table established experimentally and specified for each muscle by a simple procedure. initialization.
  • the therapist then successively applies the following procedure to each output (pair of electrodes): it delivers a frequency subtetanic pulses of the order of 8-10 Herz and raises the intensity of the stimulation current to the subject's maximum tolerance threshold; these data are then memorized by the software, then the intensity of the current being reduced to zero, the frequency is increased to 50-65 Herz and the therapist raises to again the intensity of the current up to the maximum tolerance threshold of the subject, these data being in turn memorized by the software.
  • the latter can therefore calculate, by an adequate interpolation function and with the help of the aforementioned correlation table, the enslavement of the intensity of the stimulation current by the frequency of the pulses, so that the force delivered by the stimulated muscle remains constant when the programmed frequency of the pulses varies according to the progress of the treatment program.
  • the intensity of the stimulation current delivered to each output is automatically and systematically recorded and memorized by the software as a function of the time taken for the treatment program to run.
  • the intensity thus memorized will be automatically restored on the occasion of a subsequent application of said treatment program, and this as it proceeds.
  • the intensity is subject to the programmed pulse frequency
  • the patient nevertheless retains at all times the predominant ability to modify this intensity, purely manually, by means of the control key provided for this purpose. effect.
  • the new intensity thus assigned by the patient is in turn recorded and memorized and the interpolation functions described above then automatically recalculate the new curve of the values of this parameter as a function of the running time of the treatment program.
  • the stimulator has four electrically independent outputs, galvanically isolated from each other and from the earth, and therefore called floating.
  • the programming and operation of each output, depending on the processing time of a treatment program, are completely independent. However, they can be coupled interactively by the couplings provided by the software between the various stimulation parameters as a function of the time of the treatment program, as described above. Indeed, this interactive coupling of parameters is also possible between the parameters of the different output channels.
  • FIG. 10 An example of external control and interactive parameters between two separate output channels, as a function of the processing program time t is shown in the diagram in FIG. 10.
  • the individual external control S 1 of the first channel determines the start of 'a first train of pulses; the end of it commands the establishment of a pulse train of the second channel; this pulse train is interrupted by the individual external control S 2 of this second channel; the end of this last pulse train then commands the establishment of a new pulse train of the first channel.
  • the design of the device of the present invention designed with amorphous hardware, entirely under the control of software, developed to allow free scrolling dynamic programming with interactive parameters, precisely allows programming, at will and in a manner fully evolutive, any possible interactive pattern of muscular activity, by bringing into play moreover an aerobic, anaerobic alactic or anaerobic lactic metabolism, however complex, while guaranteeing the patient a very simple application, because of the complete automatism of the course of the treatment program, of the safest, because of the safety devices described (interpolation and initialization functions) and of the most reliable, because of an absolute and essential observance.
  • the observance or compliance of the treatment consists of a feedback on the proper execution of the treatment program by the patient.
  • This feedback of certain significant parameters of said treatment, such as its duration, intensity, etc., is defined by the software and is stored on the removable and interchangeable information medium connected to the stimulator.
  • This constant observance can thus at all times be read and interpreted by the therapist.
  • Reliable compliance is an essential element of the prescribed treatment, both to guarantee the credibility of clinical studies and to reassure third-party payers, who are generally insurance companies, as to the proper use of the devices by patients at home.
  • the device of the present invention guarantees a reliable solution to this problem.
  • the impedance of the charge between a pair of electrodes is constantly measured throughout the duration of the treatment. If its value exceeds a limit value assigned by the software, the stimulation current is automatically interrupted and a specific symbol is displayed on the stimulator's LCD control screen.
  • This device makes it possible to detect and eliminate the harmful effects of any bad contact, both at the connectors, cables, electrodes, and on the skin itself. Therefore, if there is no charge between the electrodes, it is obvious that the treatment cannot be started.
  • the device when the user presses the start button of a treatment program, prior to the start of the actual stimulation, the device generates between the electrodes a constant current pulse lasting a few milliseconds, but with a very weak current intensity, largely subliminal with respect to the patient's sensitivity threshold.
  • the constant current of this pulse charges the cutaneous capacity at the level of the electrodes, it follows that the voltage necessary to supply this pulse rises progressively along a certain slope. It will be recalled for the record that if the charge between the electrodes is a purely ohmic resistance, the voltage then remains constant. It is therefore sufficient to compare the value of the slope of the measured voltage with a reference value entered in the software, so that the latter decides whether or not to launch the treatment program.
  • the advantage of this device is that it prevents not only the short-circuiting of the electrodes, but also the use of a simple dummy load with ohmic resistance. It only accepts a combined ohmic-capacitive load close to an actual body load.

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Claims (18)

  1. Vorrichtung zur elektrischen Stimulation von Muskelnerven mit zumindest einer tragbaren autonomen Stimulationseinrichtung (2; 50), die durch einen entfernbaren und austauschbaren Informationsträger (4; 53) gesteuert ist, welcher im vorhinein in Abhängigkeit der Behandlung eines jeweiligen Patienten programmierbar ist, wobei die Einrichtung mit mindestens einem Ausgang ausgerüstet ist, an den zumindest ein Elektrodenpaar (6, 6'; 56, 56') angeschlossen ist, die an dem zu behandelnden Bereich des Patientenkörpers anlegbar sind und elektrische Stimulationsimpulszüge übertragen können, durch die Kontraktionen sowie Übung oder Training der Muskeln veranlasst werden können, dadurch gekennzeichnet, dass die Stimulationseinrichtung eine in der Gesamtheit unter Kontrolle der Software stehende elektronische Hardware-Schaltung aufweist, die elektrische Stimulationsimpulszüge mit Hilfe der Elektroden überträgt und Steuereinrichtungen für Software, die auf dem austauschbaren Informationsträger gespeichert ist, aufweist, die die Übertragung der elektrischen Stimulationsimpulszüge steuern und überwachen, und dass programmierbare Einrichtungen vorgesehen sind, um während der Behandlungsdauer kontinuierlich und progressiv den Wert jedes Parameters der Stimulationsbehandlung zwischen vorab programmierbaren Referenzwerten langsam zu verändern und um eine interaktive Verknüpfung des jeweiligen Behandlungsparameters mit einem anderen Behandlungsparameter zu erlauben.
  2. Vorrichtung nach Anspruch 1, dadurch gekennzeichnet, dass die Stimulationseinrichtung einen Mikroprozessor-Generator für elektrische Impulse mit einer dynamischen Programmierung aufweist, die als Funktion des Zeitablaufes des Behandlungsprogrammes abläuft.
  3. Vorrichtung nach Anspruch 2, dadurch gekennzeichnet, dass der Mikroprozessor eine Isolationszelle (21) steuert, die einen Formverstärker für den Ausgang des Stimulationsstromes zu den Elektroden aufweist, um eine Gleichrichterstufe zu bilden, wobei die Isolationszelle durch eine elektronische Schaltstufe (26) zum Wechseln der Polarität ergänzt ist, die durch die Software unter Zwischenschaltung der Isolationszelle (22) gesteuert ist.
  4. Vorrichtung nach einem der Ansprüche 2 oder 3, dadurch gekennzeichnet, dass die elektrischen, durch den Mikroprozessor erzeugten Impulse progressiv anpassbar sind, um aufeinanderfolgende Serien von Muskelkontraktionen hervorzurufen, die wahlweise einen energetisch aeroben, anaeroben antilaktischen oder anaeroben laktischen Metabolismus ermöglichen.
  5. Vorrichtung nach einem der Ansprüche 2 bis 4, dadurch gekennzeichnet, dass die Stimulationseinrichtung von der Software und dem Mikroprozessor gesteuerte Einrichtungen aufweisen, um unterschiedliche Stimulationsparameter zu verknüpfen und sie interaktiv miteinander in Funktion des automatischen Behandlungsprogrammablaufes zu verbinden und insbesondere um die Intensität des Stimulationsstromes in Abhängigkeit der Frequenz der gelieferten elektrischen Impulse zu steuern, um auf diese Weise eine physiologische Muskelarbeit ohne Risiko für den Sehnen-Muskel-Apparat sicherzustellen.
  6. Vorrichtung nach einem der Ansprüche 2 bis 5, dadurch gekennzeichnet, dass die Stimulationseinrichtung von der Software und dem Mikroprozessor gesteuerte Einrichtungen aufweisen, um die Intensität des elektrischen, von dem Therapeuten oder dem Patienten eingestellten und an die Elektroden abgegebenen Stimulationsstromes in Funktion des automatischen Behandlungsprogrammablaufes zu speichern und um anschließend progressiv dieselbe Intensität bei einer folgenden Behandlungen abzugeben.
  7. Vorrichtung nach einem der Ansprüche 2 bis 6, dadurch gekennzeichnet, dass die Stimulationseinrichtung von der Software und dem Mikroprozessor gesteuerte Einrichtungen aufweisen, die für die Kontrolle der Einhaltung der Behandlung durch den Patienten ausgelegt sind, wobei diese Einrichtungen ständig die Impedanz der zwischen den beiden Elektroden eines jeden Elektrodenpaares während der gesamten Dauer der Behandlung messen und einen voreinstellbaren Meßtest bewirken, indem ein Impuls eines Konstantstromes mit niedriger Intensität und mit einer Zeitdauer erzeugt wird, die ausreicht, um den Vergleich des Anstieges der Spannung dieses Signales mit einem vorprogrammierten Wert zu erlauben.
  8. Vorrichtung nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, dass die verschiedenen Ausgangskanäle unabhängig voneinander programmierbar und derart ausgelegt sind, dass eine Wechselbeziehung ihrer Aktivität erlaubt ist, wobei jeder Parameter eines Ausgangskanales einen anderen Ausgangskanal steuern kann, um die Programmierung vielfältiger Muskelaktivitäten zu erlauben.
  9. Vorrichtung nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, dass die Stimulationseinrichtung Sicherheitseinrichtungen aufweist, die durch den Patienten aktivierbar sind und mit denen ausschließlich die Stimulationsintensität in vorgegebenen Grenzen einstellbar ist.
  10. Vorrichtung nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, dass die Stimulationseinrichtung einen LCD-Anzeigeschirm mit einer Matrix-Punktdarstellung aufweist, der nach TV-Art arbeitet und durch die Auswertesoftware und die das Behandlungsprogramm zur Verfügung stellende Software angesteuert wird, um die Überwachung aller Funktionen der Vorrichtung und der Stimulation zu erlauben.
  11. Vorrichtung nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, dass die Stimulationseinrichtung von der Software gesteuerte Funktionstasten (56) aufweist, die eine Personalisierung des Programmes erlauben.
  12. Vorrichtung nach einem der Ansprüche 10 oder 11, dadurch gekennzeichnet, dass der Schirm (55) und/oder die Funktionstasten (56) auf einem Klappteil (54) angeordnetsind, das als Sicherheitsdeckel dient.
  13. Vorrichtung nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, dass die Stimulationseinrichtung eine mit einem Stecker versehene Aufnahme (2) zum Einfügen von Programmkarten aufweist.
  14. Vorrichtung nach Anspruch 13, dadurch gekennzeichnet, dass vorgefertigte Programmkarten (70) vorgesehen sind, die Standard-Behandlungsprogramme liefern, wobei jedes Programm für eine präzise medizinische Indikation spezifiziert ist, wobei die Stimulationseinrichtung so eingerichtet ist, um wahlweise die Verwendung eines der Programme zu erlauben und dieses Programm auf einer Patienten-Programm-Karte (53) zu speichern, die in die Aufnahme anstatt der vorgefertigten Programmkarte (70) eingeführt wird.
  15. Vorrichtung nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, dass die Stimulationseinrichtung vier elektrisch voneinander unabhängige Ausgänge aufweist, die durch die Software durch interaktive Verknüpfungen zwischen unterschiedlichen Stimulationsparametern in Abhängigkeit des Zeitablaufes des Behandlungsprogrammes verknüpft werden können.
  16. Vorrichtung nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, dass die Stimulationseinrichtung mit einem austauschbaren Verbindungskabel (3) ausgerüstet ist, das den Anschluß einer seriellen Schnittstelle vom Typ RS 232C erlaubt, um die Verbindung mit einem Rechner (1) herstellen zu können.
  17. Vorrichtung nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, dass die Stimulationseinrichtung einen Multifunktionsstecker (61) aufweist, mit dem die Verbindung der Stimulationseinrichtung mit einem Batterieladegerät oder einer Versorgungsbatterie oder mit verschiedenen Peripherie-Steuergeräten möglich ist.
  18. Vorrichtung nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, dass sie ausgebildet ist, um eine Verbindung mit einem Datenbus für die externe interaktive Steuerung zwischen den Ausgangskanälen eines oder mehrerer in einem Netz miteinander verbundenen Stimulationseinrichtungen zu erlauben, die gegebenenfalls durch eine externe Steuereinrichtung gesteuert werden.
EP91810378A 1990-05-26 1991-05-17 Einrichtung zur neuromuskulären Elektroreizung Expired - Lifetime EP0459945B1 (de)

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DE102009017179A1 (de) 2009-04-09 2010-12-30 Fritzsche, Dirk, Priv. Doz. Dr. med. habil. Vorrichtung zur komplexen Elektromyostimulation
DE202012102393U1 (de) 2012-06-28 2013-09-30 Dirk Fritzsche Vorrichtung zur komplexen Elektromyostimulation
WO2014000736A2 (de) 2012-06-28 2014-01-03 Dirk Fritzsche Vorrichtung zur muskulären stimulation
DE202014102737U1 (de) 2014-06-12 2014-06-24 Dirk Fritzsche Vorrichtung zur elektrischen Stimulation der Beinmuskulatur
DE202014102735U1 (de) 2014-06-12 2014-06-26 Dirk Fritzsche Vorrichtung zur elektrischen Stimulation der Beinmuskulatur
US10835736B2 (en) 2014-09-05 2020-11-17 miha bodytec GmbH EMS exercise device, EMS electrode, EMS garment, EMS stimulus generating unit, EMS signal cable, and EMS undergarment for an EMS exercise device, and method for operating the EMS exercise device
US10814123B2 (en) 2014-12-18 2020-10-27 miha bodytec GmbH EMS stimulation current transmission element and EMS garment equipped with the EMS stimulation current transmission element

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US5285781A (en) 1994-02-15
DE69128213T2 (de) 1998-06-18
JP2589004B2 (ja) 1997-03-12
DE69128213D1 (de) 1998-01-02
ATE160290T1 (de) 1997-12-15
JPH04231073A (ja) 1992-08-19
ES2111557T3 (es) 1998-03-16
EP0459945A1 (de) 1991-12-04

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